糖尿病对腰椎间盘突出症经皮椎间孔镜下椎间盘切除术后疗效的影响

Effect of diabetes on the clinical effect of lumbar disc herniation after percutaneous endoscopic lumbar discectomy

目的评价糖尿病对于经皮椎间孔镜下椎间盘切除术(TPED)的腰椎间盘突出症(LDH)患者的手术效果是否存在影响。方法回顾性分析2014年1月-2017年6月清华大学附属垂杨柳医院骨科收治的行TPED治疗的69例LDH患者,其中男性32例,女性37例,年龄(58.2±14.8)岁,体重指数(BMI)(22.4±4.0)kg/m^2,根据是否患有糖尿病,分为对照组53例和糖尿病组16例。比较两组患者年龄、BMI、病程、手术节段.Pfirrmann腰椎间盘突出MRI分级、手术时间、失血量、住院时间和围手术期并发症。门诊复查随访6个月,随访内容包括Oswestry腰椎功能障碍指数(0DI)和改良MacNab标准,统计比较两组之间ODI评分、改良MacNab标准和术后并发症。计量资料组间比较采用独立样本t检验,ODI评分比较采用重复测量数据方差分析;计数资料组间比较采用Х^2检验或者Fisher精确检验;等级分组资料组间比较采用Kruskal-Wallis秩和检验。结果两组患者的平均年龄、BMI、病程、随访时间、腰椎间盘突出节段分布和严重程度比较差异没有统计学意义。糖尿病组患者住院时间明显比对照组长(t=2.095.P=0.045).糖尿病组手术时间略长(t=1.369,P=0.182),岀血量略多(t=1.833,P=0.077)。糖尿病组手术相关并发症发生率高(18.8%),复发概率也高(6.3%),而对照组手术相关并发症发生率低(3.8%),复发概率也低(1.9%),但是差异并没有统计学意义(P值分别为0.233和0.393)。糖尿病组患者术后0DI评分改善不如对照组明显(F=10.475,P=0.003),尤其是术后3个月和术后&个月0D1评分高于对照组(P值分别为0.043和0.048)o术后6个月随访时,根据改良MacNab评价标准,总体优良率为92.8%,两组比较差异有统计学意义(U=311.00,P=0.033).结论TPED是治疗LDH的安全有效的手段,能够显著改善LDH患者术后的生活质量,但是糖尿病对于术后效果有一定影响:临床工作中,为了获得更好TPED手术疗效,要重视对于糖尿病的控制。

Objective To evaluate the effect of diabetes on the effect of percutaneous transforaminal discectomy(TPED)for patients with lumbar disc herniation(LDH).Methods Retrospective analysis 69 LDH patients treated with TPED from January 2014 to June 2017 in Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University.There were 32 males and 37 females with an age of(58.2±14.8)years and body mass mdex(BMI)(22.4±4.0)kg/m^2.According to whether they had diabetes or not,they were divided into control group(53 cases)and diabetes mellitus(DM)group(16 cases).Agex,BMI,course of disease,operative segment,MRI grade of Pfirrmann lumbar disc herniation,operative time,blood loss,hospitalization time and perioperative complications were compared between the two groups.Outpatient follow-up was conducted for 6 months.The follow-up included Oswestry dysfunction index(ODI)and modified MacNab criteria.ODI score,modified MacNab criteria and postoperative complications were compared between the two groups.Independent sample t test was used to compare the measurement data between groups,and repeated measurement data analysis of variance was used to compare ODI scores,Х^2 test or Fisher exact test were used to compare the counting data between groups;Kruskal-Wallis rank sum test was used to compare the graded grouped data between groups.Results The average age,the BMI,the course of the disease,the time of follow-up,the distribution of the lumbar disc herniation and the severity of the lumbar disc were not significantly different between the two groups.The time of hospitalization in DM group was significantly longer than that in the control group(t=2.095,P=0.045).The operation time of DM group was slightly longer(t=1.369,P=0.182),and the amount of bleeding was slightly more(t=1.833,P=0.077).In DM group,the incidence of operative complications(18.8%)and the recurrence rate(6.3%)was higher,while the incidence of operative related complications(3.8%)and the recurrence probability(1.9%)was lower in the control group,but there was no statistical difference(P=0.233 and 0.393).In DM group,the improvement of ODI score after operation was not as good as that in the control group(F=10.475,P=0.003),especially in 3 months and 6 months after operation,the ODI score was higher than that in the control group(P=0.043 and 0.048).After 6 months of follow-up,the overall good rate was 92.8%according to the modified MacNab criteria,and there were significant differences between the two groups(U=311.00,P=0.033).Conclusions TPED is a safe and effective treatment for LDH,which can significantly improve the quality of life after LDH,but has a limited effect on the postoperative effect.In the actual clinical work,in order to obtain better effect of TPED operation,we should pay attention to the control of.